Know the Steps Involved to Claim Health Insurance

Today, as the medical inflation is rising every day, many people are struggling to afford quality healthcare. In such a situation, a good health insurance policy has become necessary for all. It gives you peace of mind knowing that you have a sufficient financial cushion against medical emergencies; you and your family members can get the best medical care without worrying about the cost.

If you have already purchased a health insurance policy, you must be aware of the claim filing process beforehand. This will help you get the funds without any hassles during an emergency. In this blog, we will discuss the steps involved in filing a health insurance claim.

Zurich Kotak Health Insurance Claims Process

There are two types of claim settlement – cashless claim and reimbursement claim. You must follow a specific process for both.

Steps to file a claim for Cashless Claim

1. When you want to avail cashless claim benefits for planned hospitalisation, you must check two important things.

a) If the ailment is covered as per the T&C (terms and conditions) of your health insurance policy.

b) If the hospital you want to get admitted to is part of the insurer’s network hospital. You can call and confirm with the insurer before getting admitted.

2. Before you get admitted to the hospital, inform the insurance company about the hospitalisation. At the hospital, during the admission process, you submit a pre-authorisation form at the TPA (Third Party Administrator) counter. The TPA will forward the form to the insurer for further process and cashless claim approval.

3. You must give details of your health insurance policy to the TPA desk and submit a copy of the cashless health card along with KYC documents.

4. The TPA desk sends all the documents to the Insurance company. The claim initially is adjudicated at the TPA although you will get approval for the cashless claim from the insurance company.

5. At the time of discharge The TPA sends the documents again and you receive the final approval from the insurance company. The bills will be directly settled by the insurance company without you having to pay any cash except the non medical expenses as mentioned in the policy wording of IRDA

Steps to follow for reimbursement

At times you have to get admitted to the hospital that is not in the network hospital list or you may have to pay the bils in emergency. In such a situation. You can get reimbursement of the expenses, irrespective of getting treatment at the network hospital or non-network hospital or if you fail to get a cashless claim.

1. Call us (Zurich Kotak General Insurance) at our toll free number 1800 266 4545 about the health insurance claim and submit the reimbursement form within 30 days from the date of discharge.

2. Attach all the original copies of medical bills and medical reports (stamped and signed by the hospital authorities). Make sure to keep a copy of all the documents for your records. The hospital bill must clearly mention the hospital’s registration number.

3. After you get discharged, the hospital will give you a discharge summary or discharge card, which claims that you are fit to be discharged. You must submit this card to the insurer along with the bills and the claim settlement form.

4. If your doctor recommends post-hospitalisation treatment or care, you must also submit follow-up prescriptions. You can submit the bills within 60, 90 or 120 days of getting discharged, as per the policy terms to get compensation for post-hospitalisation expenses.

5. Once you submit all the documents, the insurer will verify the same, and reimburse the amount within 12-15 days.

Final Word

You may have the best health insurance policy but it will prove useful only if you claim the expenses. Follow these tips and you can be sure to get a quick and hassle-free settlement of all your claims.

We, Zurich Kotak General Insurance have a simple claim approval process. You can visit our Health insurance page to know more about the process, and other health insurance plans.